Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder among women of reproductive age that significantly impacts their reproductive health. Acupuncture and its combined therapies may have beneficial effects on the endocrine and metabolic states of women with PCOS. This systematic review and meta-analysis evaluated the treatment effects and potential mechanisms of acupuncture and its combined therapies compared to oral metformin in treating PCOS patients.The evaluation focused on three sets of outcomes: hormonal indicators, metabolic indicators, and body weight indicators. Studies that involved additional therapies beyond the specified interventions or included patients with other diseases were excluded. Additionally, data mining methods were used, including frequency statistics to analyze the frequency of acupuncture points and the meridians involved, and the Apriori algorithm to perform association rule analysis for the most effective interventions.The study included 46 articles (51 studies) involving six interventions: acupuncture combined with metformin, acupuncture treatment, acupuncture with Chinese herbal medicine and metformin, acupuncture with Chinese herbal medicine, acupuncture combined with cupping, and auricular acupuncture combined with metformin showed significant improvements in all evaluated indicators. Data mining revealed the Stomach meridian of foot yangming was the most frequently used, and the most commonly used combination of points included CV4, SP6, and ST36.This study suggests that acupuncture and its combined therapies may benefit PCOS. However, risk of bias and heterogeneity observed were noted. Future high-quality, rigorously designed randomized controlled trials are needed to confirm these findings and provide stronger clinical recommendations for acupuncture in PCOS treatment.